American Frontline Healthcare Personnel's Access to and Use of Personal Protective Equipment Early in the COVID-19 Pandemic.
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ABSTRACT: Objectives
To quantify adequacy of personal protective equipment (PPE) for U.S. healthcare personnel (HCP) at the outset of the COVID-19 pandemic and its association with infection risk.Methods
March-May 2020 survey of the national Nurses' Health Studies and the Growing Up Today study regarding self-reported PPE access, use and reuse. COVID-19 endpoints included SARS-CoV-2 tests and COVID-19 status predicted from symptoms.Results
Nearly 22% of 22,232 frontline HCP interacting with COVID-19 patients reported sometimes or always lacking PPE. Fifty percent of HCP reported not needing respirators, including 13% of those working in COVID-19 units. Lack of PPE was cross-sectionally associated with two-fold or greater odds of COVID-19 among those who interacted with infected patients.Conclusion
These data show the need to improve the U.S. infection prevention culture of safety when confronting a novel pathogen.
SUBMITTER: Rich-Edwards JW
PROVIDER: S-EPMC8562916 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectivesTo report frontline healthcare workers' (HCWs) experiences with personal protective equipment (PPE) during the COVID-19 pandemic in the UK. To understand HCWs' fears and concerns surrounding PPE, their experiences following its guidance and how these affected their perceived ability to deliver care during the COVID-19 pandemic.DesignA rapid qualitative appraisal study combining three sources of data: semistructured in-depth telephone interviews with frontline HCWs (n=46), media reports (n=39 newspaper articles and 145?000 social media posts) and government PPE policies (n=25).ParticipantsInterview participants were HCWs purposively sampled from critical care, emergency and respiratory departments as well as redeployed HCWs from primary, secondary and tertiary care centres across the UK.ResultsA major concern was running out of PPE, putting HCWs and patients at risk of infection. Following national level guidance was often not feasible when there were shortages, leading to reuse and improvisation of PPE. Frequently changing guidelines generated confusion and distrust. PPE was reserved for high-risk secondary care settings and this translated into HCWs outside these settings feeling inadequately protected. Participants were concerned about differential access to adequate PPE, particularly for women and Black, Asian and Minority Ethnic HCWs. Participants continued delivering care despite the physical discomfort, practical problems and communication barriers associated with PPE use.ConclusionThis study found that frontline HCWs persisted in caring for their patients despite multiple challenges including inappropriate provision of PPE, inadequate training and inconsistent guidance. In order to effectively care for patients during the COVID-19 pandemic, frontline HCWs need appropriate provision of PPE, training in its use as well as comprehensive and consistent guidance. These needs must be addressed in order to protect the health and well-being of the most valuable healthcare resource in the COVID-19 pandemic: our HCWs.
| S-EPMC7818840 | biostudies-literature
Project description:BackgroundThe appropriate use of personal protective equipment (PPE) can significantly reduce the risk of infection associated with caring for patients. This study aimed to investigate the knowledge, awareness, and behaviors related to the PPE usage among frontline nurses in a nationally designated coronavirus disease 2019 (COVID-19) hospital during the COVID-19 pandemic.Materials and methodsThe study was performed in two phases: (1) a questionnaire survey to assess the knowledge, awareness, and behaviors related to PPE use, and (2) in-depth personal interviews to elaborate the survey findings. The questionnaires were distributed to all 121 registered nurses in three isolation wards and an intensive care unit which dedicated for patients with COVID-19 and 102 nurses completed survey (84.3% response rate). In-depth interviews were conducted with a total of 7 nurses.ResultsAmong the survey participant, 100% stated that they knew how to protect themselves while providing nursing care and 93.1% stated that they knew the recommended PPE by task. Most survey participant mainly wore gloves, face shield, N95 or equivalent respirator, and a long-sleeved gown, but one-third of the participants sometimes used coveralls instead of long-sleeved gown. In-depth interviews, the importance of timely updated and specific guidelines for selecting the appropriate type of PPE was highlighted. The adequate supply of PPE, convenience at work, and the role of responsible leadership mainly determined behaviors related to the PPE.ConclusionAs new information on COVID-19 continues to emerge, the up-to-date and specific PPE guideline with evidence should be prepared. The spread of accurate information, the role of accountable leadership, and the active communication under positive organizational culture are important for the proper use of PPE.
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Project description:During the doffing of personal protective equipment (PPE), pathogens can be transferred from the PPE to the bodies of healthcare workers (HCWs), putting HCWs and patients at risk of exposure and infection. PPE doffing practices of HCWs who cared for patients with viral respiratory infections were observed at an acute care hospital from March 2017 to April 2018. A trained observer recorded doffing performance of HCWs inside the patient rooms using a pre-defined checklist based on the Centers for Disease Control and Prevention (CDC) guideline. Doffing practices were observed 162 times during care of 52 patients infected with respiratory viral pathogens. Out of the 52 patients, 30 were in droplet and contact isolation, 21 were in droplet isolation, and 1 was in contact isolation. Overall, 90% of observed doffing was incorrect, with respect to the doffing sequence, doffing technique, or use of appropriate PPE. Common errors were doffing gown from the front, removing face shield of the mask, and touching potentially contaminated surfaces and PPE during doffing. Deviations from the recommended PPE doffing protocol are common and can increase potential for contamination of the HCW's clothing or skin after providing care. There is a clear need to change the approach used to training HCWs in PPE doffing practices.
| S-EPMC7157959 | biostudies-literature
Project description:The SARS-CoV-2 virus is highly infectious resulting in increased infection and death among the front-line Healthcare Workers (HCW) because of limited access to personal protective equipment (PPE). This study assesses the availability and self-reported use of PPE amongst HCW during the COVID-19 pandemic in Nigeria. A mixed-method study was conducted through a cross-sectional survey and in-depth interviews amongst HCW. Quantitative data analysis was done using SPSS version 26 and thematic analysis was done for the in-depth interview. A total of 258 HCW completed the survey while 15 HCW took part in the in-depth interview. The mean age was 40 (±8.6) years, 67.4% were female and 83.3% were married. 49% were Doctors, 21.1% were Nurses, 28.7% were other allied HCW and 62.2% had at least 10 years of practice experience. Only 22.1% of HCWs had regular access to PPE and only 20.6% had access to N-95 facemask compare to other PPEs. Male HCWs and those working at secondary or tertiary facilities had access to N-95 facemask (p-value 0.025 and 0.010 respectively). The facilitator of PPE use is leadership quality of hospital head and donation of PPE to the facilities while the barriers to PPE use include a limited supply of PPE, as well as facility's infrastructural and operational challenges. The study reported limited access to essential PPE with varying perspectives on its use. Therefore, access, knowledge, and appropriate use of PPE need urgent attention with improved implementation of infection control policy at the facility level.
| S-EPMC8133390 | biostudies-literature
Project description:GetUsPPE.org has built a centralized platform to facilitate matches for PPE donations, with an active role in matching donors with the appropriate recipients. A manual match process was limited by volunteer hours, thus we developed an open-access matching algorithm using a linear programming-based transportation model. From April 14, 2020 to April 27, 2020, the algorithm was used to match 83,136 items of PPE to 135 healthcare facilities in need across the United States with a median of 214.3 miles traveled, 100% of available donations matched, met the full quantity of requested PPE for 67% of recipients matched, and with 46% matches under 30 miles traveled. Compared with the period April 1, 2020 to April 13, 2020, when PPE matching was manual, the algorithm resulted in a 280% increase in matches/day. This publicly available automated algorithm could be deployed in future situations when the healthcare supply chain is insufficient.
| S-EPMC7846564 | biostudies-literature
Project description:BackgroundHealthcare professionals (HCPs) are at the frontline in the fight against COVID-19 and are at an increased risk of becoming infected with coronavirus. Risk of infection can be minimized by use of proper personal protective equipment (PPE). The aim of this study was to assess the availability and use of PPE, and satisfaction of HCPs with PPE in six public hospitals in Addis Ababa, Ethiopia.MethodsA cross-sectional study was conducted among 1134 HCPs in June 2020. A systematic random sampling and consecutive sampling techniques were used to select the study participants. Data were collected using a self-administered questionnaire. Descriptive statistics were used to describe the data and Chi-square test was used to assess the association between the groups. Bivariate and multivariable logistic regression models were used to assess factors associated with satisfaction of healthcare workers.ResultsThe mean (±SD) age of the participants was 30.26 ± 6.43 year and 52.6% were females. Nurses constituted about 40% of the overall sample, followed by physicians (22.2%), interns (10.8%), midwives (10.3%) and others (16.7%). The majority (77%) of the HCPs reported that their hospital did not have adequate PPE. A critical shortage of N95 respirators was particularly reported, it only increased from 13 to 24% before and during COVID-19, respectively. The use of N95 increased from 9 to 21% before and during COVID-19, respectively. Almost 72% of the respondents were dissatisfied with the availability and use of PPE in their hospital. The independent predictors of the respondents' satisfaction level about PPE were healthcare workers who reported that PPE was adequately available in the hospital (adjusted OR = 7.65, 95% CI:5.09-11.51), and preparedness to provide care to COVID-19 cases (adjusted OR = 2.07, 95% CI:1.42-3.03).ConclusionsA critical shortage of appropriate PPE and high level of dissatisfaction with the availability and use of PPE were identified. Therefore, urgent efforts are needed to adequately supply the healthcare facilities with appropriate PPE to alleviate the challenges.
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Project description:BackgroundIn limited resource settings, compliance to proper personal protective equipment (PPE) use is challenging. This study aims to characterize the pattern of PPE use among healthcare workers (HCWs) during the first wave of coronavirus diseases-2019 (COVID-19) in Egypt and to determine the factors associated with compliance to the proper use of PPE.MethodsA cross-sectional study was conducted among Egyptian HCWs using an online self-administered questionnaire. Participants were classified as "Compliant" or "Non-compliant" according to their score.ResultsA total of 404 responses were analyzed, with a mean age of 36.6 ± 8.4 years, and 56.4% were females. Non-compliant HCWs represented 53.2% of participants. The majority reported shortage in N95 respirators (91.3%) and practiced extended PPE use (88.1%). Better compliance to proper PPE use was reported: females (51.3%, p = 0.05), Physicians (54.2 %, p = 0.005), medical specialities (34.7 %, p < 0.001), <10 years' work experience (42.9%, p = 0.05) and working > eight hours/day (71.3%, p < 0.001). The significant predictors for compliance were; receiving prior training on the proper use of PPE (OR: 4.59, CI: 2.22-9.47, p ≤ 0.001), exposure to COVID-19 patients (OR: 2.75, CI: 1.19-6.35, p = 0.02) and performing procedures that pose HCWs at a high risk of exposure to Severe Acute Respiratory Syndrome Coronavirus 2 (OR: 2.21, CI: 1.04-4.71, p = 0.04). The high percentage of non-compliant HCWs turns on a warning signal. Increase the availability of PPE, prioritize their use, provide more focus on training of HCWs and monitor their compliance is highly recommended.
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Project description:BACKGROUND:In the COVID-19 era physicians have to face with need to perform office procedures maintaining the maximum safety for both the patient and the Doctor himself. The purpose of this paper was to suggest some equipment useful to perform outpatient visits in an ENT setting. METHODS:A simple modification of the standard headlight used during an ENT visit provides the operator a better face protection without any impairment in vision and comfort. In addition, in order to perform a safer ENT examination, a droplet protective barrier has been adapted to the patient's chair. RESULTS:Both the devices have been texted with success during a period of 2 months in our ENT clinic. No cases of contamination have been registered among physicians. CONCLUSION:A simple modification to a device used in the routine ENT activity implemented its protective efficacy with low costs. On the other hand, a more structured tool permitted to obtain a more protected environment during patient examination.
| S-EPMC7333584 | biostudies-literature
Project description:BackgroundHealthcare workers (HCWs) are at high risk of SARS-CoV-2 infection. Effective use of personal protective equipment (PPE) reduces this risk. We sought to determine the prevalence and predictors of self-reported access to appropriate PPE (aPPE) for HCWs in the UK during the COVID-19 pandemic.MethodsWe conducted cross sectional analyses using data from a nationwide questionnaire-based cohort study administered between December 2020-February 2021. The outcome was a binary measure of self-reported aPPE (access all of the time vs access most of the time or less frequently) at two timepoints: the first national lockdown in the UK in March 2020 (primary analysis) and at the time of questionnaire response (secondary analysis).ResultsTen thousand five hundred eight HCWs were included in the primary analysis, and 12,252 in the secondary analysis. 35.2% of HCWs reported aPPE at all times in the primary analysis; 83.9% reported aPPE at all times in the secondary analysis. In the primary analysis, after adjustment (for age, sex, ethnicity, migration status, occupation, aerosol generating procedure exposure, work sector and region, working hours, night shift frequency and trust in employing organisation), older HCWs and those working in Intensive Care Units were more likely to report aPPE at all times. Asian HCWs (aOR:0.77, 95%CI 0.67-0.89 [vs White]), those in allied health professional and dental roles (vs those in medical roles), and those who saw a higher number of COVID-19 patients compared to those who saw none (≥ 21 patients/week 0.74, 0.61-0.90) were less likely to report aPPE at all times. Those who trusted their employing organisation to deal with concerns about unsafe clinical practice, compared to those who did not, were twice as likely to report aPPE at all times. Significant predictors were largely unchanged in the secondary analysis.ConclusionsOnly a third of HCWs in the UK reported aPPE at all times during the first lockdown and that aPPE had improved later in the pandemic. We also identified key determinants of aPPE during the first UK lockdown, which have mostly persisted since lockdown was eased. These findings have important implications for the safe delivery of healthcare during the pandemic.
| S-EPMC9255515 | biostudies-literature
Project description:PurposeThe supply of N95 masks and filtering facepiece respirators (FFRs) has been limited nationally owing to the coronavirus disease 2019 pandemic. Ultraviolet C (UVC) light has been suggested as a potential option for decontamination of FFRs by the Centers for Disease Control. There has been a lack of publications characterizing UVC dose distribution across FFRs.Methods and materialsA UVC light box and FFR rack system was assembled using low-pressure mercury lamps peaked at 254 nm and aluminum flashing to reduce shadowing effect. Dose was characterized with the use of ultraviolet (UV) intensity labels and an ultraviolet germicidal irradiation (UVGI) National Institute of Standards and Technology traceable meter. Ozone production was evaluated after extended bulb run time.ResultsCalibration of UV intensity labels was noted to have color-change saturation at 100 mJ/cm2. Dose measurements with the UV intensity labels on the FFR demonstrated symmetrical dose to all surfaces, but symmetry was not supported by measurements with the UVGI meter. There was substantial dose fall off on the lateral aspects of the FFR. No ozone production was noted in the UVC system.ConclusionsUV intensity labels for characterization of dose provided a false suggestion of symmetry compared with the UVGI meter. Estimates of appropriate exposure times to reach 1000 mJ/cm2 should be significantly increased to account for geometry of FFR and lateral dose fall off.
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